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Drowning among fishing communities on the Tanzanian shore of lake Victoria: a mixed-methods study to examine incidence, risk factors and socioeconomic impact
  1. Hilary S Whitworth1,2,
  2. Joyce Pando1,
  3. Christian Hansen3,4,
  4. Natasha Howard5,
  5. Amen Moshi1,
  6. Otto Rocky1,
  7. Happiness Mahanga1,
  8. Mtoro Jabbar1,
  9. Philip Ayieko1,4,
  10. Saidi Kapiga1,4,
  11. Heiner Grosskurth1,4,
  12. Deborah Watson-Jones1,2
  1. 1 Mwanza Intervention Trials Unit, Mwanza, Tanzania
  2. 2 Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
  3. 3 Uganda Virus Research Institute, Entebbe, Uganda
  4. 4 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  5. 5 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Hilary S Whitworth; hilary.whitworth{at}lshtm.ac.uk

Abstract

Objectives To estimate the incidence of unintentional fatal drowning and describe associated risk factors among Lake Victoria fishing communities, and to assess perceived social, financial and other impacts among families and colleagues of persons who drowned.

Design A retrospective, observational mixed-methods study, conducted between September 2017 and February 2018.

Setting Eight Tanzanian fishing communities on Lake Victoria.

Participants Persons who drowned in the preceding 24 months were identified using an extensive community networking approach. Adult family members, colleagues or community members familiar with the habits and behaviours of people who drowned and/or circumstances of drowning incidents participated in surveys (n=44) and in-depth interviews (n=22).

Main outcome measures Pooled drowning incidence, with sensitivity analyses allowing for uncertainties in population estimates. Risk factors were identified through the evaluation of behavioural characteristics of persons who drowned and circumstances of drowning incidents. Perceived socioeconomic impacts were assessed through semi-structured interviews with their family members and colleagues.

Results The estimated drowning incidence was 217/100 000 person-years (95% CI 118 to 425/100 000). Of 86 victims identified, 70 (81%) were fishermen (79% aged 18–40 years; all men) and 9 were children (all ≤10 years). All deaths occurred in the lake. Most adults (65/77; 84%) were fishing from a boat when they drowned; 57/77 (74%) died in the evening (from ~5 pm) or at night. Six children (67%) drowned while swimming/playing at the lakeshore unsupervised. Few victims (2/86; 2%) were wearing a life jacket at the time of death. Reported socioeconomic impacts of these deaths ranged from income loss to family break-up.

Conclusions Drowning is a significant risk in Tanzanian lakeside fishing communities, with estimated mortality exceeding national incidence rates of fatal malaria, tuberculosis or HIV, but preventative strategies appear uncommon. Socioeconomic impact at the family level may be substantial. Intervention strategies are required to reduce the drowning burden among this neglected at-risk population.

  • drowning
  • injury
  • fishing communities
  • low and middle income countries
  • epidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors HSW, CH and HG: conceptualised the study. HSW and CH: wrote the study protocol. HSW provided study oversight, with support from CH, DW-J, SK and HG. JP: responsible for day-to-day study coordination and management of field staff. JP also conducted data collection together with research assistants AM, HM, OR and MJ. CH: led analyses of drowning incidence estimations, and HSW and PA produced data tables for all other quantitative data. NH and AM: conducted qualitative analyses and interpretation. HSW: drafted the manuscript, with contributions from all authors. All authors had full access to all study data and reviewed and agreed on the version of the manuscript for submission.

  • Funding This study was funded by Royal National Lifeboat Institution.

  • Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

  • Competing interests The Royal National Lifeboat Institution (RNLI) provided study funding but played no role in the study design, data collection, analysis and interpretation, or manuscript writing. For the duration of the study, funding from the RNLI contributed partial salary costs for HSW and NH, and full salary costs for JP, OR, AM, HM and MJ. HSW, SK, CH, PA, NH, DW-J and HG receive funding support from LSHTM.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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